Study: Sex-Differences in COVID-19 Diagnosis, Risk Factors and Disease Comorbidities. Image Credit: Kzenon/Shutterstock

Study reveals disparities in clinical outcomes of COVID-19 in the US based on gender

In a recent study published on Research Square* Preprint server, Researchers examined gender differences among patients with coronavirus disease 2019 (COVID-19) in the United States (US).

Study: Gender differences in the diagnosis of COVID-19, risk factors and disease comorbidities. Image credit: Kzenon/Shutterstock

Studies report greater severity and mortality related to COVID-19 in men compared to women worldwide; however, the mechanisms of sex-based differences in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are unclear. Previous research observations suggest that researchers need to consider patient gender as an important variable for interpreting COVID-19 data.

About studying

In this study, researchers examined gender-based differences in sociodemographic characteristics, lifestyle factors, and comorbidities among patients with COVID-19.

This study included 62,310 male and female patients with COVID-19 with diagnoses confirmed between January 2020 and December 2021 by polymerase chain reaction (PCR) and immunoglobulin G (IgG)/IgM analysis. Data were retrospectively obtained from the COVID-19 Research Database. In addition, secondary data related to patient health claims records and electronic health records (EHR) were extracted from the Healthjump database.

EHRs included medical and social history (race, language, ethnicity), demographics (gender, age), vital signs (such as blood pressure, oxygen saturation), immunizations, medications, and diagnosis (eg, diabetes, hypertension, etc.); meetings. , procedures and meetings. Logistic regression models were used for analysis and adjusted odds ratios (AORs) were determined.

Results and discussion

Age-related increases in COVID-19 cases were seen in men and women, and the most severely affected individuals were aged 50 to 59 years, i.e. 3,628 men and 6,418 women. Among the study participants, 13%, 9.4%, 12.3%, 15.5%, 17.7%, 16.3% and 15.9% were aged <20 years, 20 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, 60 to 69 years and >70 years or

Substantial differences in comorbidities and sociodemographics were noted between female and male patients, e.g. a significantly greater proportion of men (vs. women) were aged >70 years (17% vs. 15%) and were smokers (11% vs. 9, 2%, (OR = 1.4). In addition, diabetes (8.8% vs. 6.5%) and hypertension (4.4% vs. 3.9%) were significantly more common in men compared to women with values AOR 22.9 and 66.2, respectively.Influenza was more likely in men than in women (OR = 66.2).

Substantial gender-based differences in laboratory parameters, comorbidities, and vaccination were noted among SARS-CoV-2-positive individuals. A slightly higher proportion of SARS-CoV-2 positive men had mild hypoxemia compared to women (9.3% vs. 7.1%, (OR = 1.3). A higher proportion of men reported caffeine use (77.4% vs. 75 .9%), alcohol (30.7% versus 22.4%) and drugs (6.6% versus 5.2%) and were obese (55.1% versus 54.3%) or overweight (31% versus 26%).

On the other hand, a greater proportion of women than men encountered health services for genetic susceptibility testing and clinical examination (14.6% vs. 13.9%), thyroid disorders (4.4% vs. 2.5%), and dissociative and other stress-related mental illness. and anxiety (2.9% vs. 1.9%), although men suffered significantly more personality and behavioral disorders and intellectual disabilities than women (OR = 89.7). Furthermore, no significant gender differences were noted for living conditions, transportation, vaccines, and exercise.

SARS-CoV-2-positive men showed a higher frequency of comorbid conditions such as hypertension and diabetes and abnormal laboratory and clinical findings based on data adjustments for covariates such as education, ethnicity, and age. The results of this study were consistent with studies on COVID-19 conducted in Europe, China, and the US, which reported a disproportionate impact of COVID-19 between men and women.

The study results showed a strong and independent association between male gender and increased susceptibility to COVID-19. Men are reported to be more likely to engage in risky practices such as alcohol consumption and smoking. In addition, smoking habits are associated with adverse outcomes of COVID-19, as smoking increases pulmonary angiotensin-converting enzyme 2 (ACE2) expression and therefore enhances SARS-CoV-2 invasion of the host, which may explain the association between smoking and COVID-19 severity. . In addition, alcohol consumption and smoking predispose men to comorbidities such as pulmonary disorders and cardiovascular disorders.

Gender-based differences intersect with the roles or social differences between men and women that affect the outcomes of COVID-19. Men commonly work in occupations and sectors that require social interaction (eg agriculture, food production and/or distribution, pharmacy or food sales and production, security and transport). More frequent social gatherings, including removing the mask for smoking and drinking, increase men’s exposure to SARS-CoV-2.

In addition, males and females respond differently to self and foreign antigens with sex-based immunological differences. Studies report higher expression of the cytokines interleukin (IL)-8 and 18 in men, while increased T cell activation in women in COVID-19 and association of poor T cell responses with COVID-19 outcomes.


Overall, the study findings highlighted sex-based differences in lifestyle factors, comorbidities, and sociodemographic characteristics of COVID-19, the understanding of which would aid in clinical decision-making regarding the provision of medical care to patients with COVID-19. Furthermore, these findings could inform COVID-19 policy-making and improve global preparedness and effectiveness of health interventions.

*Important notice

Research Square publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered conclusive, guiding clinical practice/health-related behavior, nor should they be treated as verified information.

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